Pollicization of the Index Finger

~s recorded a 

it. 

that they have 

~o comments in 

~ne tumors in the 

pie reported a car 

chondroblastoma 

¯ In my series of 

¯ pal involvement. 

ladelphia. J. B. Lip 

: Surg., 35-A: S88-893~) 

Flynn, pp. 1027-103 

as, 1957. 

¯ 43-A: 861-864, Se 

:!roma of Bone. Arch. 

nts. pp. 169-195. 

s and Feet. Radiology~ ;’ 

. A Case Report. Bull. 

9-148, 1937. 

scano, 1957. 

v of 110 Cases. J. 

AND JOINT SURGERY 

Pollicization of the Index Finger 

METHOD ~’: AND RESULTS IN APLASIA AND HYPOPLASIA OF THE THUMB 

BY DIETER BUCK-GRAMCKO, M.D.’~, HAMBURG. GERMANY 

From the Department of Hand Surgery and Plastic Surgery, 

Berufsgenossenschaftliches Unfallkrankenhaus Hamburg 

Children with congenital absence or marked hypoplasia of the thumb usually 

skillful in the use of their hands. Despite this natural dexterity, the important 

pul?

1606 DIETER BUCK-GRAMCKo 

FIG. 

Figs. :~ 2-A and 2-B: Disappointing result of a trial to pollicise the index finger performed else~ 

where. An osteotomy of the metacarpal and resection of the proximal interphal~ngeal joints was 

done, but the essential features of shortening muscle stabilization, and adequate rotation were 

lacking. , 

results presented in this paper show that these statements are not correct if small but 

important details of technique are observed. 

The technique of pollicization in congenital cases is based on the procedure: 

evolved for the reconstruction of the thumb in traumatic amputations. From the fas 

cinating literature concerning this problem, I would emphasize the contributions in 

operative technique by Gosset, Hilgenfeldt, and Littler 10,11, who developed 

fundamental principles for pollicization in cases of aplasia and hypoplasia of the 

thumb. Other authors such as Harrison z, s and Riordan 12 also have made important 

contributions. ’ 

From 1959 to the present I have performed 114 pollicization operations, and 

of this number 100 were in congenital cases. The experience with this large number 

of pollicizations has led to modifications in the operative technique with improvement 

of the results z,3,4. Twenty-one of the seventy-three patients had unilateral 

problems, with normal contralateral upper extremities. In sixteen there were ot 

THE JOURNAL OF BONE AND JOINT suRGERY 

(Fig. 

vide!

performed 

mgeal joints was 

.re rotation 

.~ct if small 

the 

From the 

retributions in 

developed 

oplasia of 

ade important 

perations, and 

large number 

~vith improvehad 

unilateral 

~re were other 

JOINT sURGERy 

POLLICIZATION OF THE INDEX FINGER 

1607 

lformations of the other hand which did not require pollicizations with the excepof 

nine in whom the procedure will soon be done. This leaves twenty-seven pa- 

..nts who had the procedure done bilaterally. 

Twelve of the patients who had pollicization also had a radial club hand on the 

~ide operated on, and six of them had the condition bilaterally; but I did not pollicize 

the index finger in any patient with bilateral involvement. However, I did perform 

a centralization procedure on the contra[ateral hand in two of the six patients 

ith bilateral involvement. In this procedure the hand was centralized over the end 

’ the ulna. 

Theoretical Concepts 

In creating a new thumb from the index finger with stability and optimum posi- 

.tion. the reduction of the length of the bones is important. For attaining the same 

nun:L)er of bones and joints as in a normal thumb a shortening of the over-all length 

of the ray is necessary: the second metacarpal is removed with the exception of its 

head which acts as the new trapezium. However, the metacarpal should not be allowed 

to continue to grow much; for this reason the epiphysis must be resected. The 

metacarpophalangeal joint will then become the new carpometacarpal joint. The 

~roximal phalanx of the index will become the first metacarpal and the proximal interphalangeal 

joint the metacarpophalangeal joint of the new thumb, and so forth 

(Fig. 3). 

A rotation of the index finger on its longitudinal axis is also performed to provide 

proper axial alignment. Rotation of only 90 degrees, as is often done, will not 

giv.= good oppositio~.,:The result will be a type of key grip against the long finger. 

The index finger has to be initially rotated about 160 degrees during the operation 

so that it is opposite the pulp of the ring finger. This position changes somewhat 

during the suturing of the muscles and the skin, so that at the end of the operation 

there is rotation of about 120 degrees. 

In addition to the shortening and rotation, an angulation of about 40 degrees of 

palmar abduction should be obtained. In this way, the new thumb is then well placed 

to later move in opposition as well as in adduction and-abduction- 

DIP 

Ext. ind.

1608 DIETER BUCK-GRAMCKO 

FIG. 4 

Photographs showing a long (left) and a short thumb (right) after pollicization of the index 

finger. 

Operative Technique 

For the pollicization operation there are four basic principles of equal importance, 

relating to the following: (a) the neurovascular pedicle; (b) the skeletal 

readjustment with preservation of the metacarpophalangeal joint; (c) the muscular 

stabilization; (d) the skin incision. 

The first, the technique of fashioning the neurovascular pedicle, is now well 

known. The freeing-up of the neurovascular bundle between the index and the long 

finger is obtained by ligating the artery to the radial side of the long finger. The common 

digital nerve is then carefully separated into its component parts for the two 

adjacent fingers. This ensures that no tension will be present after the index finger is 

rotated. Sometimes an anomalous neural ring is fot]nd around the artery 5. This ring 

Fro. 5 

Roentgenogram of a hyperextension 

deformity with dorsal subluxation of-the 

former metacarpophalangeal joint. 

(Fig. 4). The metacarpal head is fixed 

is split very carefully so that angulation of the 

artery after transposition of the finger will 

not occur. The radial digital artery to the index 

finger is occasionally absent. In such 

cases it is possible to perform the 

tion on a vascular pedicle of only one 

On the dorsal side at least one of the great 

veins must be preserved. ~. 

For skeletal fixation after bone readjustment, 

the length of the index finger is of considerable 

importance. If the phalanges are 

relatively short, the base of the metacarpal 

must be retained in order to obtain the right 

length of the new thumb. The metacarpal 

head is fixed to its base by means of one or 

two Kirschner wires. If the phalanges are 

normal length, the whole metacarpal is resected 

with the exception of its head. A 

short thumb is desirable , as it is functionally 

and esthetically better than a long one, which 

bears too close a resemblance to a finger 

by sutures to the joint capsule and the carpal 

THE JOURNAL OF BONE AND JOINT SURGERY 

Diagram of reduc 

the metacarpal head 

be,~es, which in ,. 

not essential. Fit: 

good function. 

The physiol~ 

especially in the 

my earlier cases / 

deformity is now 

so that its palma 

phalanx is broug 

head. The norma 

Sl~0n is possible. 

creased the stabil 

observed. 

For muscle 

trinsic mechanis~ 

intrinsic muscles 

for the mobility, 

than mobility fo~ 

necessary to sho~ 

months to the sh: 

degree. One of t:. 

is severed at thc 

metacarpal resec 

first metacarpal) 

proprius tendon 

The ~ intero. 

of the thumb, q 

lateral bands of 

partially strippc 

necessity. 

VOL. 53-A, NO. 8, D1

:ation of the ind, 

es of equal 

(b) the skeletal 

c) the muscular, 

:.le, is now well 

iex and the long( 

inger. The comz 

arts for the two 

e index finger 

tery 5. This rin 

mgulatic 

¯ the finger wil 

artery to the in’ 

~bsent. In such 

,’n the 

only one 

,ne of the 

ljus 

finger is of 

phalanges 

the metacarpal 

obtain the ri 

7he 

~eans of one 

halanges are 

~tacarpal is re- 

)f its he~id. 

:is functionally 

ong one, which 

Ice to a 

: and the carpal) 


1609 

Fta. 6 

Diagram of reduction, rotation, and angulation of the index finger: in the circle the turning of 

the metacarpal head for prevention of the hyperextension deformity is shown. 

bones, which in young children can be pierced with a sharp needle. Bone union is 

not essential. Fibrous fixation of the head to its new surroundings is sufficient for 

good function. 

The physiologically wide range of movement of the metacarpophalangeal joint, 

~ecially in the child, was the reason that hyperextension deformity developed in 

my earlier cases (Fig. 5). It was more disturbing esthetically than functionally. This 

deformity is now prevented by turning the metacarpal head about 70 to 80 degrees 

so that its palmar side becomes proximal (Fig. 6)."In other words, the proximal 

~halanx is brought into a position of hyperextension in relation to the metacarpal 

head. The normal joint looseness is markedly reduced and hardly any further extenis 

possible. This procedure, combined with the new muscle attachments has inicreased 

the stability of the thumb. No further tendency to hyperexten~ion has been 

:i bbserved. 

For muscle stabilization, the adjustment of the extensor tendons and the inmechanism 

is one of the most important steps of the operation (Fig. 7). The 

muscles and the long extensor and flexor tendons are responsible not only 

for the mobility, but also for the stability of the digit. Stability is more important 

than mobility for good function of the thumb. Experience has shown that it is not 

to shorten the flexor tendons. They adapt themselves in the course of a few 

months to the shortening of the ray and will then flex the new thumb to the required 

’ee. One of the two extensor tendons, that of the extensor digitorum communis, 

is severed at the metacarpophalangeal level; its proximal end is sutured, after the 

metacarpal resection, to the base of the former proximal phalanx (now acting as 

first metacarpal), to become the new abductor pollicis longus. The extensor indicis 

proprius tendon is shortened and then resutured by end-to-end anastomosis. 

The interosseus muscles of the inde, x finger are also important for stabilization 

of the thumb. They should first be detached from the proximal phalanx and the 

lateral bands of the dorsal apone-urosis. Their origins from the metacarpal bone are 

partially stripped subperiosteally. Careful preservation of nerves and vessels is a 

necessity. 

VOL. 53-A, NO. 8, DECEMBER 1971


FtG. 7 

Diagram of the muscle stabilization by the two interossei resutured to the separated 

bands of the dorsal aponeurosis. The extensor communis tendon is fixed to the base of the new:¯ 

metacarpal as an abductor polticis longus; the extensor indicis proprius tendon is shortened. 

After osteotomy and resection of the second metacarpal, the head of the second 

metacarpal must be set in the aforementioned position between the muscles in 

a way that they hold the bone well. The stabilization of the ray will be ensured 

resuturing the tendinous insertions of the two interossei to the lateral bands of the 

dorsal aponeurosis. These lateral slips will have been separated from the middle; 

band the entire length of the proximal phalanx. The slips are woven through 

distal parts of the muscles and turned back to form a loop. In this way, the 

palmar interosseus will become an adductor pollicis, and the first dorsal 

an abductor brevis. 

The new way of attaching the muscles is accompanied by a further change 

the skin incision. Previously, an S-shaped incision was made on the radial side 

the hand with an oval incision at the base of the index finger. Now, since the 

terossei are reattached in the neighborhood of the proximal interphalangeal joint, 

additional dorsal longitudinal incision over the proximal phalanx is needed. 

the volume of the space comprising the proximal phalanx has been increased 

muscle and tendon transfers, direct closure is not possible. A dorsal skin flap 

to close this defect. 

In order to obtain this flap, the incision is made more palmarly than 

It also continues as far as the middle of the phalanx (Fig. 8). The distal end 

flap is excised. 

Follow-up 

Each patient was seen routinely during the first year after operation, and 

after at two years, four years, and six to eight years. Depending on the year in 

the operation was done, follow-up was as follows: twelve years, one patient; 

eight years, seven patients; four to six years, twenty patients; tWO to four 

twenty-five patients; one to two years, seven patients, and less than one year, 

patients. Many of the patients had bilateral involvement: this accounts for the 

THE JOURNAL OF BONE AND JOINT 

ons (100). 

betwc 

The main 

on took 

tee weeks of 

uld move ju~" 

dren gained th~ 

:and some coul~ 

the sixth to 

!the operation. 

There 

Diagram of the 

facilitate 

VOL. 53-A NO. 8, D

ted lateral 

of the new 

.’ned. 

le second 

s in such 

~sured by 

ds of the 

ough 

the first 

terosseus"::~: 

:hange in i 

~.1 side 

:e the 

joint, 

ed. Since’:: 

radially. 

ad of this 

in 

nt; six 

ur 

., thirteen 

r the 


crepancy between the number of patients (seventy-three) and the number of pollicizations 

(100). 

Results 

1 61 1 

The main change in the range of motion and in the dexterity of the hand operated 

on took place during the first two years after the operation. At the end of the 

three weeks of immobilization after operation, the joints of the pollicized index finger 

could move just a few degrees, usually; but in the next three to six weeks, all children 

gained the ability to perform pinch between the new thumb and the long finger, 

and some could even touch the thumb to the ring finger. Most children could do this 

by the sixth to eighth week, and could touch the little finger four to five months after 

the operation. 

There was no significant difference in the rate of improvement with different 

Fro. 8 

Diagram of the new incision (above) and suture line at the end of the operation (below). 

letters facilitate the orientation for shifting of the different skin flaps. 



ages, except for infants under the age of fifteen months, who could not cooperate to 

demonstrate pinch, but even these infants were able to use the hand operated on in a 

natural way and were gripping objects between the new thumb and fingers or between 

the new thumb and the long finger. Active flexion of the pollicized finger sometimes 

began in the fourth week, but in the majority not before the third month. The 

motion increased slowly but steadily during the first year because of slow adaptive 

shortening of the flexor tendons, not shortened surgically. 

The motion and strength of radial abduction was the greatest variable in the 

group of patients. They depended not only on the strength of the extensor muscle, 

and on the position of fixation of the metacarpal head relative to the remains of its 

base on the carpal bones, but also on the active use, and on the presence of other 

anomalies in the extremity. For instance, in the radial club hand, there usually was 

little active motion in the interphalangeal joints of the index and long fingers, and. 

therefore, after pollicization, little motion existed in the former metacarpophalangeal 

joint and none in the interphalangeal joints. In this case, therefore, the digit had to 

be fixed in less radial abduction and act more as a post for the function of pinch. 

All of the children used their new thumbs naturally except those with radial 

club hand, who frequently used the side-to-side grip of ring and long fingers for 

smaller objects. One other exception was a child with a "five fingered" hand, who 

used this method for pinch preoperatively and continued to do so because of insufficient 

power in the intrinsic muscles. None of the new thumbs showed sensory or 

vascular deficiency with one exception a hand in which there was anomalous absence 

of the pahnar arteries and postoperative thrombosis of the metacarpal artery 

with necrosis and subsequent loss of the thumb. 

It was necessary to add skin grafts in six operations, in three of which scars 

from previous operations were the reason. In the other three a small lull thickness 

graft was used from the excess skin on the dorsum of the finger. In these the reason 

was retention of much of the second metacarpal because of the shortness of the 

phalanges. 

The reattached intrinsic muscles were important for the appearance as well as 

for the function of the thumb. They gave to the transposed index finger the appearance 

of a thumb. They also produced a real thenar eminence, and, after a period 

of training, led to relatively normal mobility of the thumb (Fig. 9). 

Fro. 9 

Normal opposition and radial abduction of a pollicised index finger with a real thenar eminence 

by the described muscle transfer. 

THE JOURNAL OF BONE AND JOINT SURGERY 

Hyg 

years 

on th 

were 

were 

rotat~ 

biliz~: 

perf~ 

radi: 

the , 

ring 

pop 

vOI

could not cooperate 

’. hand operated on in 

mb and fingers or 

pollicized finger SOme- 

~ the third month. The 

:ause of slow adaptive 

reatest variable in the 

f the extensor muscle, 

e to the remains of its 

the presence of other 

and, there usually was 

and l~ng fingers, and, 

metacarpophalangeal 

efore, the digit had to 

function of pinch. 

:ept those with radial 

and long fingers for 

fingered" hand, who 

~ so because of insuf- 

Os showed sensory or 

"e was anomalous abthe 

metacarpal artery :’ 

three of which scars 

a small full thickness 

r. In these the 

the shortness of 

ppearance as well as 

index finger the a 

e, and, after a period 

9). 

ith a real thenar emi- 

AND JOINT SURGERY 

POLLICIZATION OF THE INDEX FINGER 1613 

Fro. 10 

Hypoplastic thumb in the left hand in a boy of the age of five; result of pollicization three 

years later. 

The quality of the results depended on the preoperative state of the hand, and 

the additional anomalies on muscles, tendons, bones, and .joints. The best results 

were in hands with a hypoplastic thumb (Fig. 10). The bones of the hypoplasfic digit 

were removed, but the intrinsic muscles were left to provide intrinsic power .for the 

rotated index finger. These muscles gave the ne_w thumb normal balance ~ind stabilization, 

which are the prior conditions for good mobility, as well as the ability to 

pinch and normal prehension (Fig. 1 1). 

In cases of radial club hand, usually there were several additional anomalies 

: and bad mobility of the radial fingers; the postoperative results in these cases were 

! not as good as those previously described, but the operation did provide an increase 

in function and usefulness of the hand. The correctionof the club hand by centralization 

of the hand with removal of the lunate and capitate bones and tendon transfers 

performed at the first operation, the pollicization at the second (Fig. 12). 

In the case of the so-called five-fingers-hand the decision whether or not the 

radial finger was to be removed or used for pollicization sometimes was difficult. If 

the radial finger was of about the equal size of a normal finger, pollicization of this 

finger gave a very satisfactory result (Fig. 13). If the finger was too small and hypoplastic, 

it was better to remove it and pollicise the index finger. 

Finally, the optimum age for performance of the operation was the first year of 



Result three years after pollicization; normal position in writing and crochet-work. 

life. At the beginning, I considered’that the age of two and a half years was most appropriate. 

However, in the last few years I have operated upon several infants, the 

youngest being eleven weeks old, and now I think that the first year of life is the best 

age for pollicization and, incidentally, for some other operations in congenital m-a-l-: 

formations of the hand. There are two decisive factors here: The first is that it is 

from the age of about six months onward that the so-called thumb feeling is sup- 

FIG. 12 

Result in radial club hand with centralization of the hand and pollicization of the index finger. 

THE JOURNAL OF BONE AND JOINT SURGERY

and crochet-work. 

xlf years was most ap- 

~n several infants the 

year of life is the 

~ns in congenital real; 

The first is that it is 

thumb feeling is 

Lion of the index finger. 

~E AND JOINT SURGERY 


FIG. 13 

"Five-fingers-hand" before and after pollicization of the radial finger. 

1615 

posed to develop, and, therefore, the new thumb will be felt as being a normal one. 

The second is the fact that the transposed index finger will have the longest period 

possible for growth under the influence of its function as a thumb. Several years after 

pollicization we have been able to demonstrate a slow transformation of the structures 

of the pollicized index finger in the direction of a normal thumb. Not only do 

th: muscles become stronger, but also the bones. Especially the new first metacarpal 

becomes larger than the first phalanx of the long finger, to which it was equal in size 

preoperatively (Fig. 14). 

The operation was not done in the mildest cases of hypoplasia of the thumb, 

in which there was only absence of thenar muscles and a slight adduction contracture. 

In all other cases of hypoplasia, in which there were not enough good intrinsic muscles 

and long flexor and extensor tendons for good function, the dysplastic thumb was 

removed, and the index finger was pollicized. The operation also was not done in 

radial club hands where centralization of the hand over the ulna was not possible be- 

of restriction of elbow motion. 

Fro. 14 

Roentgenograms of a hand with pollicized index finger four years after operation. Note the 

broadening of the base of the new first metacarpal in contrast to the base of the long finger. 



Su mmary - 

The experiences with 100 operations of pollicization of the index finger in congenital 

deformities of the thumb in seventy-three patients are reported on. The operation 

is indicated in aplasia and in hypoplasia if there is no stable metacarpopha_ 

langeal joint and there are adduction contracture and poor mobility due to abnormal_ 

ities of aluscles and tendons. The operative technique was improved by the experiences 

in twelve years of use. Most important are the bone fixation and the muscle 

stabilization. In transformation of an index finger into a thumb it is necessary to 

shorten the ray, to rotate it sufficiently, and to give it the right angle of abduction. 

The shortening takes place in the metacarpal bone with preservation of its head: 

the metacarpophalangeal joint becomes now the carpometacarpal joint and the metacarpal 

head the new trapezium. For preventing a hyperextension deformity it is 

necessary to rotate the metacarpal head For good muscle stabilization and good 

mobility the two interossei of the index finger have to be detached and to be fixed in 

the shortened position on both sides of the new thumb to the mobilized lateral slips 

of the dorsal aponeurosis. This new manner of muscle fixation gives a very good 

thenar eminence not only in respect to appearance but also in function with full or 

nearly full opposition and abduction. It requires a new skin incision with a dorsoradial 

skin flap for covering the gap between the wound edges of the former proximal 

phalanx broadened by the muscle masses. The excellent results show a surprising .... 

adaptation of bones and soft tissues due to function and growth--a reason for an 

earl), performance of the operation. :. 

References 

1. BROOKS, DONAL: In Rehabilitation of the Hand. Ed. 2, pp. 336-348. Edited by C. B. Wynn 

Parry. London, Butterworths, 1966. 

2. BUCK-GRAMCKO, DIETER: Operative Behandlung einer Spiegelbild-Deformit~t der Hand. 

Ann. Chir. Plast., 9; 180-183, 1964. 

3. BUcK-GRAMCKO, DIETER: Daumenrekonstruktion bei Aplasie und Hypoplasie. Kiln. Med., 

21; 325-329, 1966. 

4. BUCK-GRAMCKO, DIETER: Indikation und Technik der Daumenbildung bei Aplasie und 

Hypoplasie. Chit. Plast. Reconstr., 5:46-51. 1968. 

5. EDGERTON, M. T.: SNYDER, G. B.; and WEB~, W. L.: Surgical Treatment of Congenital 

Thumb Deformities (Including Psychological Impact of Correction). J. Bone and Joint 

Surg., 47-A-" 1453-1474, Dec. 1965. 

6. GOSSET, J.: La poIIicisation de l’index (Technique chirurgicale). J. Chir., 65:403-411, 1949. 

7. HARRISON, S. H.: Restoration of Muscle Balance in Pollicization. Plast. Reconstr. Surg., 34; 

236-240, 1964. 

8. HARRISOr~, S. H.: Pollicisation in Cases of Radial Club Hand. British J. Plast. Surg., 23~ 

192-200, 1970. 

9. HILGENFELDT, OTTO: Operativer Daumenersatz und Beseitigung v0n Greifst6rungen bei 

Fingerverlusten. Stuttgart, Ferdinand Enke Verlag, 1950. 

10. LITTER, J. W.: The Neurovascular Pedicle Method of Digital Transposition for Reconstruction 

of the Thumb. Plast. Reconstr. Surg., 12:303-319, 1953. 

11. LITTLER, J. W.: Digital Transposition. In Current Practice in Orthopaedic Surgery, Vol. 3, 

pp. 157-172. St. Louis, The C. V. Mosby Co., 1966. 

12. RIORDhN, D. C.: Congenital Absence of the Radius. J. Bone and Joint Surg., 37-A: 

1140, Dec. 1955. 

13. WroTE, W. F.: Pollicisation for the Missing Thumb, Traumatic or Congenital. The Hand, 

1: 23-26, 1969. 

14. WHITE, W. F.: Fundamental Priorities in Pollicization. J. Bone and Joint Surg., 52-B: 438- 

443, Aug. 1970. 

DISCUSSION 

.DR. J. W. LITTLER, NEW YORK, N. Y.: Through a tragic pharmacological mishap 

Buck-Gramcko has gathered this unprecedented series (100 cases) of thumb aplasia. His paper 

a splendid one and therefore a pleasure to discuss: its clarity is refreshing, the surgical approach 

is exact, and the functional reward for these little patients is superior. His outstanding contribution 

gives great authority to this particular procedure. 

Several points, however, deserve emphasis. First: the surgical timing. For many years I 

have resisted transposing the radial digit into thumb position during infancy, believing that the 

THE JOURNAL OF BONE AND JOINT SURGERY

function with full or 

cision with a dorso- 

the former proximal 

:s show a surprising 

th--a reason for an 

Edited by C. B. Wynn 

Deformit/it der Hand. 

ypoplasie. Klin. Med., 


ically unmolested child, possibly with another anomaly, would better tolerate the operation 

i later. Never, however, have I hesitated to encourage the removal, relatively early, of any rudie 

index finger in con- 

:eported on. The o 

;table metacarpopha_ 

~. i:;!~:!~;.i rnentary, functionally and hopelessly blighted first pre-axial digit. 

It is acknowledged that the thumbless child will endeavor to force his independent index 

finger as an opponent of the other digits. What we attempt with our surgery is to complete that 

!!~:!l(i ~ endeavor. Both Dr. Buck-Gramcko and Dr. Riordan now firmly believe that the digital transpotity 

due to abnormal, sition should be done during infancy. This may or may not be true for the best result. It is my 

,roved by the experi_, !i!i~, opinion that a non-existing thumb has no special cortical representation; any oppositional functtiorl 

and the muscle tion resides in the next most independent digit, regardless of the time of any transposition. 

nb it is necessary to 

Heretofore, I have awaited the age of from two to four, but perhaps my approach is too cau- 

¯ angle of abductiot 

tious, despite parental pressure. 

Certain technical aspects are most important and of these the incision is of primary con- 

:rvation of its head: 

cern, for finally the closure must have allowed the digit to be shifted into proper position, pro- 

11 joint and the meta- viding an adequate cleft and a sufficient proximal phalangeal skin envelope to house the bulk of 

~sion~deformity it is 

the intrinsic muscles advanced to encompass the recessed proximal phalanx (now acting as the 

~bilization and 

ed and to be fixSd in 

metacarpal). 

Though it is not carefully documented in this paper, the head of the epipyseal-arrested 

metacarpal fails to develop, but as shown in some of the illustrations, the hypertrophic proximal 

.obilized lateral slips 

phalanx has taken on the characteristics of a thumb metacarpal. It also shows good projection 

n gives a very good 

(despite an incomplete carpal arch) and has a firm fibrous base to meet the oppositional de- 

:tung bei Aplasie und 

,atme~it of Congenital 

~). J. Bone and Joint 

:.. 6~: 403-411, 1949. :21 ?~ 

st. Reconstr. Surg., 34: 

;sh J. Plast. Surg., 23: 

m Greifst6rungen bei 

nsposition for 

~aedic Surgery, Vol. 3, 

int Surg., 37-A: 

7ongenital. The Hand, 

;0int Surg., 52-B: 

~cological mishap Dr. 

,b aplasia. His paper " 

. the surgical approach 

; outstanding contribu- 

ncy believing that the 

1 617 

mands. In the words of Sir Charles Bell: 

"On the length, strength, free lateral motion and perfect mobility of the thumb, depends 

thepower of the human hand. The thumb is called Pollex because of its strength; and that 

strength is necessary to the power of the hand, being equal to that of all the fingers." 

It must be admitted that to bring the thumb-deprived primitive hand into a more advanced 

state, the pre-axial finger can be substituted through careful surgery and that ~vith time and use, 

though imperfect, its appearance and function will approach quite nearly that prime digit which 

faiied to develop. 

: AND JOINT SURGERY ~ ~i~,~ VOL. 53-A, NO. 8, DECEMBER 1971

Pollicization of the Index Finger

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